After the data collection period for CPT codes 99453 and 99454, the physiologic data that are collected and transmitted may be analyzed by a ‘‘physician or other qualified health care professional, qualified by education, training, licensure/regulation.” This code includes only professional work and does not contain any direct practice expense (PE). The valuation for CPT code 99091 includes a total time of 40 minutes of physician or NPP work, broken down as follows: 5 minutes of preservice work (for example, chart review); 30 minutes of intra-service work (for example, data analysis and interpretation, report based upon the physiologic data, as well as a possible phone call to the patient); and 5 minutes of post-service work (that is, chart documentation).
What to Know About CPT 99091
CPT 99091 was created in the early 2000s to code for remote patient monitoring. Its descriptor: "Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days." For a period after the newer codes discussed above were introduced, it was not advisable to bill using CPT 99091 because of limitations and requirements.
However, that changed with the 2021 Medicare physician fee schedule final rule that permitted providers to begin billing CPT 99091 with newer codes. Federal rules now allow providers to bill for "complex" RPM management when they are required to spend substantial time managing the patient and their remote patient monitoring care plan.
Furthermore, CMS stated that CPT 99091 can be billed each 30 days whenever such complex provider management occurs and without affecting a provider's ability to bill clinical staff time via CPT 99457 each month.
Billing Codes
Collecting and Analyzing Physiologic Data
99091